NPIMap

Organization Active NPI

Story County Community Life Program

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Ames, IA
National Provider Identifier
1851526586
Registry record updated May 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
0895425 Issued in IA
Legal business name
STORY COUNTY COMMUNITY LIFE PROGRAM
Practice address
104 S Hazel Ave
Ames, IA 50010-5952
Phone
(515) 956-2600
Fax
(515) 956-2609
NPI assigned
May 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Gayla R Harken, MS
Title
Director
Phone
(515) 956-2602

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 0895425 IA Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 0895433 IA
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 0895441 IA

Addresses

Primary practice location

104 S Hazel Ave
Ames, IA 50010-5952

Mailing address

104 S Hazel Ave
Ames, IA 50010-5952
Phone (515) 956-2600

Other identifiers 1

IdentifierTypeStateIssuer
1366516114MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Story County Community Life Program9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1851526586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S HAZEL AVE",
            "city": "AMES",
            "state": "IA",
            "postal_code": "500105952",
            "telephone_number": "515-956-2600",
            "fax_number": "515-956-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S HAZEL AVE",
            "city": "AMES",
            "state": "IA",
            "postal_code": "500105952",
            "telephone_number": "515-956-2600",
            "fax_number": "515-956-2609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STORY COUNTY COMMUNITY LIFE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-26",
        "last_updated": "2009-05-26",
        "status": "A",
        "authorized_official_last_name": "HARKEN",
        "authorized_official_first_name": "GAYLA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "515-956-2602",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IA",
            "license": "0895425",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IA",
            "license": "0895433",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IA",
            "license": "0895441",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366516114",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ames, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.